MAXimising Benefits

THE MONTHLY MAGAZINE ON HEALTHCARE ICTS, MEDICAL TECHNOLOGIES & APPLICATIONS

Satish Kini

Pg 25

Founder Director & Chief Mentor 21st Century Health Management Solutions Pvt Ltd

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VOLUME 5 / ISSUE 10 / OCTOBER 2010 ` 75 / US $10 / ISSN 0973-8959

MAXimising Benefits The IT outsourcing deal puts Max Healthcare on the roadmap for becoming the best IT-enabled hospital chain in the country

Dr Neena Pahuja CIO Max Healthcare

Dr Pervez Ahmed CEO & Managing Director Max Healthcare

Dr Pankaj Gupta Client Executive â&#x20AC;&#x201D; Max Healthcare Dell Services

CONTENTS

VOLUME 5 | ISSUE 10 | OCTOBER 2010 | ISSN 0973-8959 WWW.EHEALTHONLINE.ORG

COVER STORY

MAXimising Benefits Divya Chawla

DEVELOPMENT DIMENSION RFID ADVANTAGE IN 34 THE HEALTHCARE

Pg. 08

Prof Akhil Chandra, Academic Head, Logistics & Supply Chain, ILAM, ICRI

IN CONVERSATION IS A NECESSARY 37 “IT MANAGEMENT TOOL FOR HOSPITALS”

SPOTLIGHT

MY JOURNEY

CAUSE, MEANS 14 “THE ITO DEAL HAS BEEN A 25 FIND FOLLOW POSITIVE LEARNING FOR US” Dr Pervez Ahmed, CEO and Managing Director, Max Healthcare

ZOOM IN IT DOWN 18 TRACK Sangita Ghosh De

Satish Kini, Founder Director & Chief Mentor, 21st Century Health Management Solutions Pvt Ltd

TECH TRENDS NEW AGE HEALTH 27 THE ‘EXPERTS’ Dr Bhupinder Chaudhary, Assistant Professor, Department of Hospital Management, HNG University; Baljit Saini, Lecturer, SBBSIET; and Rishu Gupta, Lecturer, SBBSIER

APPLICATIONS ON DATA 30 COUNTING Dr Sanjeev Sood, Hospitals and Health Systems Administrator

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Dr Mehdi Khaled, Vice President, Healthcare and Life Sciences, Oracle Corporation

EVENT REPORT BENEFIT FOR 40 TAX EMPLOYEE HEALTH COVER Sangita Ghosh De

REGULAR COLUMNS

42 NEWS REVIEW LAST PAGE SECURITY, END 50 BUILD BLOOD SCARCITY Dr Rajesh Gopal, Managing Director, Gujarat State AIDS Control Society

Presents

HEALTHCARE LEADERSâ&#x20AC;&#x2122; FORUM November 26, 2010 The Claridges, New Delhi

..a pulsating platform for connecting with CXOs of healthcare industry For advertising opportunities: Arpan Dasgupta, E: arpan@elets.in, M: 9818644022

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In the Right

Network

magazine reaches to all hospitals in the network of all major health insurers

For advertising opportunities: Arpan DasGupta, 9818644022, arpan@elets.in Rakesh Ranjan, 9953972742, rakesh@elets.in

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EDITORIAL

VOLUME 5 | ISSUE 10 | OCTOBER 2010 WWW.EHEALTHONLINE.ORG

Hospitals Do ‘IT’ Realising the potential of information and communication technologies in transforming healthcare delivery and accelerating business growth, hospitals in India are now shifting their focus on ICT implementation to become world-class care delivery centres. One of the biggest and the most unique hospital IT implementation projects in India, the Max Healthcare and Dell Services partnership has put Indian hospitals on the road to achieve excellence of global standards. Costing `90 crore for a period of 10 years, Max Healthcare is convinced that the benefits achieved because of this project will far outweigh the investments made. eHEALTH tracks the successful completion of one year of the project, benefits achieved, challenges faced during implementation and plans and strategies for the future in the Cover Story of this issue.

PRESIDENT: Dr. M P Narayanan EDITOR-IN-CHIEF: Dr. Ravi Gupta MANAGING EDITOR: Shubhendu Parth VP - STRATEGY: Pravin Prashant PRODUCT MANAGER: Dipanjan Banerjee (Mob: +91-9968251626) Email: dipanjan@elets.in EDITORIAL TEAM: Dr. Prachi Shirur, Dr. Rajeshree Dutta Kumar, Divya Chawla, Sheena Joseph, Yukti Pahwa, Sangita Ghosh De, Pratap Vikram Singh, Gayatri Maheshwary SALES & MARKETING TEAM: Arpan Dasgupta (Mobile: +91-9818644022), Bharat Kumar Jaiswal (+91-9971047550), Debabrata Ray, Anuj Agarwal, Fahimul Haque, Priya Saxena, Rakesh Ranjan, Vishal Kumar (sales@elets.in) SUBSCRIPTION & CIRCULATION: Manoj Kumar, Gunjan Singh (subscription@elets.in) GRAPHIC DESIGN TEAM: Bishwajeet Kumar Singh, Om Prakash Thakur, Shyam Kishore WEB DEVELOPMENT TEAM: Zia Salahuddin, Amit Pal, Sandhya Giri, Anil Kumar IT TEAM: Mukesh Sharma EVENTS: Vicky Kalra EDITORIAL CORRESPONDENCE: eHEALTH, G-4 Sector 39, NOIDA 201301, India, tel: +91-120-2502180-85, fax: +91-120-2500060, email: info@ehealthonline.org eHEALTH does not neccesarily subscribe to the views expressed in this publication. All views expressed in the magazine are those of the contributors.

A major component of the Max and Dell IT outsourcing deal is the implementation of a comprehensive electronic medical record that will not only store the entire clinical information of in-patients and out-patients, but it will also provide them with a unique passwordprotected URL that can be used by them anywhere in the world for accessing their health records. The Zoom In section this month highlights the importance of electronic medical records and key market parameters in India, as well as across the globe. India and China are expected to be primary growth drivers globally as they have the potential to implement innovative technologies, such as cloud-based EMR solutions. The latest technologies in the health IT basket, such as the use of radio-frequency identification (RFID) for tacking purposes, health expert systems that guide physicians in offering accurate care, the importance of data analytics in healthcare have been highlighted in the Development Dimension, Tech Trends and Applications sections respectively. Further, we are pleased to inform the launch of a new section in the magazine—My Journey that highlights the life and journey of some of the known leading personalities in the healthcare sector, who through their steadfast commitment to achieve their goals, have left an indelible mark. We hope that you enjoy reading this issue of eHEALTH, as much as we enjoyed creating it!

Themagazine is not responsible or accountable for any loss incurred, directly or indirectly as a result of the information provided. eHEALTH is published by Elets Technomedia Pvt. Ltd in technical collaboration with Centre for Science, Development and Media Studies (CSDMS) Owner, Publisher, Printer - Ravi Gupta, Printed at R P Printers, G-68, Sector-6, Noida, UP, INDIA and published from 710 Vasto Mahagun Manor, F-30, Sector - 50, Noida, UP, Editor: Dr. Ravi Gupta

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org

October 2010 < www.ehealthonline.org <

COVER STORY

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MAXimising Benefits The IT outsourcing deal puts Max Healthcare on the roadmap for becoming the best IT-enabled hospital chain in the country By Divya Chawla

he Indian healthcare system has recently realised the potential of information and communication technologies in completely transforming care delivery at hospitals. The industry witnessed its first complete IT infrastructure technology outsourcing deal in September 2009, when Max Healthcare and Dell Services (formerly Perot Systems) partnered for developing IT operations at all Max Hospitals. The cost of the deal, Rs 90

crore (excluding infrastructure cost), is an indicator of the increased priority that is now being given by Indian hospitals to IT, which is an extremely positive sign. As per the agreement, the deal will last for ten years, out of which one year has already passed, and a lot of positive transformation has already been noticed. The unique partnership is not only expected to provide a lot of value to Max Healthcare in terms of enhancing the quality of services and reducing treatment costs, but

it will also be a great learning experience for Dell, which marked its entry into the Indian healthcare market with this deal.

Status update Post its inception in September 2009, the ITO deal will last for 10 years and which, according to Dell, will comprise of three major phasesâ&#x20AC;&#x201D;transition, improving productivity and optimisation. As one year has passed, the transition phase is almost over. During this phase Dell

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COVER STORY

â&#x20AC;&#x153;We now have a centralised database of all our patientsâ&#x20AC;?

Dr Neena Pahuja

CIO, Max Healthcare

Give us more details about the IT outsourcing project that is being implemented by Dell. The contract has two parts. The first part deals with end-to-end infrastructure development and maintenance with a complete data centre upgradation in link with Dellâ&#x20AC;&#x2122;s central data centre and servers. Secondly, we have a business continuity plan in long term. As a part of the contract, we have got a resonance link that connects all our hospitals in different locations, enables us to do audio and video conferencing using the latest tele-commu-

installed the entire IT infrastructure for Max, by migrating the already existing IT infrastructure to a modern infrastructure. The entire data centre of Max, which was housed in their Okhla office, was migrated to the Dell facility in Noida. To reduce hassles, the shifting work was done during off hours on weekends, so that the work at the hospitals does not get affected. The entire process lasted for a couple of months and currently all Max Hospitals are running from the data centre housed in the Dell facility in Noida. The servers and network devices have been installed with monitoring devices that generate alerts in case a problem arises. There is also a situation management process in

nication equipments, decreasing the cost over a period of time. Besides, the facilities are also going to benefit the patient in terms of his convenience of being served in any of the branches of Max located anywhere. We have now got a centralised database of all our patients with latest information connected through the central data centre. The process in coordinating with the process and selecting the vendor-partner took an end to end analysis of the terms and conditions. Before outsourcing it completely we did a more than two years research on the pros-and-cons of the implementation of the process and evaluation of the quality of

place to ensure that even the problems of highest criticality get resolved within a definite period of time. The second part of the transition phase comprised of the application part. With eight applications already in place, Dell is now building an all extensive Electronic Health Record (EHR) system for Max. Based on the VistA open source, initially developed by the Veterans Affairs (VA) in the US, the EHR at Max is expected to take some more time before it can become fully functional at all Max facilities. Max decided upon implementing VistA by customising it as per Indian needs, so that the best practices can be brought to India. In addition to creating electronic health

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records for all in-patients, Max plans to go a step ahead by creating records for the outpatient department, as well. This will be the first-of-its-kind initiative in India. The record for out-patients will be maintained for a certain period of years, as required to manage data storage constraints. Max Healthcare strongly believes that once the EHR system is in place, the benefits for management, physicians as well as patients at Max will increase tremendously. A more recent update has been the conversion of the entire IT infrastructure of all Max Hospitals on a private multiprotocol label switching (MPLS) cloud running remotely from data centre at Dell facility in Noida. This step has set the

the products to make them more user friendly, particularly for the doctors. Then the vendor selection was done that matched closest to our requirements. One of the critical phases in the healthcare industry is change management. Many hospitals have gone for EHR but could not implement it properly because anything that is implemented has to be doctor friendly. Max was conscious about it and took care of it from the very beginning. Any of the products that were planned to bring in were scanned through the doctorsâ&#x20AC;&#x2122; comments to make it customised further enhancing its usability. In the process of selection of any of the products we see a high engagement of the clinicians because we believe its not the IT vendor who uses the products its the doctor and clinician who use the product. Therefore, according to our experiences, adoption is the best policy of change management. While implementing the basic format of the infrastructure by Dell project, all the clinicians in Max have been conveyed about all the information and knowledge about the products, including its usage and even a minor detail about the project. Therefore, there is no push for the IT implementation in the project, rather there is a pull from the doctors and clinicians in the process. However, while working together in the project, Dell is only responsible for developing the infrastructure, support and maintenance and Max is responsible for product searching, selection and procurement. So, what is your long term IT strategy? How do you plan to integrate it with the growth plan of Max? In long term, IT has been considered for the development of having clean and quick data and good processes so that business research and analytics can be utilised in a bigger way through which we can carry out the best of the practices across all our hospitals. Currently Max Healthcare is in the process of introducing

stage for the launch of the EHR system at Max in the coming times. The required bandwidth is being provided by Bharti and Reliance to ensure load balancing, which is around 15 Mbps by each vendor. As the load of applications increases, Max is ready to enhance this bandwidth to manage all applications. A significant advantage that this cloud will offer is the capability to add more hospitals/ networks as and when required without any hassles. With the MPLS cloud in place making new hospitals/facilities IT enabled will be a cakewalk as they only need to be connected to the cloud. While the transition phase is almost over, Dell believes that it will take another

and implementing Electronic Health Records (EHR) system for better management. The next step we are looking at is â&#x20AC;&#x2DC;Future State Workshopâ&#x20AC;&#x2122; through which we will analyse all our processes to find the complications involved, if those complications can be eliminated and the process efficiency can be re-looked at. The idea is to give the patient the complete benefit of the upgraded method of communication and information technology. After implementing 3G solutions, adopting the structure and practice of tele-medicine is one of the future projects that we have in our mind which will be followed by tele-radiology. In our long term vision we have data analysis, knowledge management system, and clinical pathways supporting the para-medics and doctors together in our planning. With these facilities and infrastructure we think that we would prepare ourself for a total remote monitoring system. We are also planning to go into the system of HIE (Health Information Exchange) in the next one and half years, if not now, where our consumers (patients) can freely take their data whenever they have the requirement. But still a lot needs to be there in place for HIE because I see no readyness in this particular field. I personally feel that this should be initiated through a PPP mode with strong support from the government. Besides, Max has also initiated the process of medical e-Learning for its staffs with the training procedure for any new IT infrastructure and product that is deployed overtime in the infrastructure. For EHR we have taken support from the open source learning product and creating an e-Learning course which is compliant to the process and software of EHR. This is also helping us in doing monitoring and getting feedback of the learning process as well as the performance of the application. Now we want to replicate it with other applications and training procedures.

year for the productivity improvement phase to finish, where Dell will focus on redeveloping and improving all inefficiencies, if any, to make the functioning of all IT operations seamless. The final phase will comprise of optimising all processes. All these phases would take around 3-4 years to get completed, before Max can actually start reaping the benefits of IT implementation.

The benefit quotient The IT implementation at Max Healthcare will not only benefit the management and physician community, but it will also be extremely advantageous for the patients. This would be the first time in the country when electronic health records

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COVER STORY

“The rapid developments at Max have happened because of the ITO model they adopted” Dr Pankaj Gupta

Client Executive — Max Healthcare Dell Services What were the major challenges being faced by Max? How will Dell’s solutions help Max overcome these challenges? Max had an in-house IT team of about 15 people and they had a few vendors who were supporting IT services. However, this model was not giving them enough value as a lot of capital was being invested with insufficient return on investment. Moreover, Max was looking at having one entity that can manage all IT processes and they wanted to outsource these services and that is how they joined hands with us.We are responsible for the infrastructure services as well as the applications at Max. Infrastructure starts right from cables, servers, network devices, data centres, day-to-day operations and so on. Max already has eight different applications and further we are implementing a VistA EHR application. We migrated the existing IT infrastructure at Max to a modern infrastructure. There was a transition project, when we joined Max, in which we started from a point where the data centre was situated in Max Hospital at Okhla. We migrated that to our data centre and all other Max hospitals are now running from our data centre at Noida. This was a huge project, which lasted for a couple of months. We also took over 14 of their people, who are now a part of our team. As a strategic decision, we did not take over the office of

the CIO because somebody was needed to be there at Max as a signing authority. We put automatic monitoring devices on the network devices and servers. If there is any sort of problem in the functioning, the monitoring devices raise an alert. If the issue is not acted upon within a certain time frame, people are required to sit on a SitMan bridge, which is a situation management process. On the network side, we migrated everything to an MPLS cloud. The infrastructure is now ready, and we just need to put all other applications. Tell us about the governance process that has been put in place at Max. We set a complete governance process for Max internally. We did this because this is part of our model and we want to bring in the best practices to Max. For this, we set up a Clinical Reference Group (CRG), which is headed by a very senior physician within the hospital. This group has physicians and representatives from almost all departments. Further, we have sub-committees of the CRG. We consolidated all sub-committees so that when the EHR comes, a joint decision can be taken. We also set up an HIS council for Max to prioritise all processes on the admin side of the business. This council is headed by one of the hospital administrators. On top of these two councils, we have another council which is headed by the CEO. Any decisions taken by these

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two councils gets rolled up in the governance council and the policies become implemented throughout. On top of the governance council, there is an executive council, which has members from both organisations at the board level as well as very senior executive level. Initially decision making was difficult, however, with the governance process now in place these issues have got resolved. Why did Max choose VistA for its EHR? VistA was developed by and for the Veterans Affairs (VA) in the US, which is an equivalent of Military hospitals in India. All VA hospitals, about 1000, in the US, run on VistA. A very few organisations have implemented VistA outside the US. As per the FOIA act in the US, VA could not have proprietary rights over the software because it was developed using the tax payers’ money and hence it was put in the open source and that was the time when World VistA was created. Max wanted to pick up the open source VistA to build best practices on it that can be used anywhere in India. VistA has everything that is required for a hospital to run. It has the clinical functions for all departments and the ancillary functions including laboratory, radiology pharmacy. The only thing that VistA lacks, from an Indian context, is billing and material management.

for the out-patient department will be maintained. Although, this would be a big challenge for Max in terms of storing such huge amounts of data generated by the OPD, yet they are confident that the benefits achieved because of this will outweigh the challenges. Moreover, each and every patient at Max will be provided with a unique URL, that will store all patient information. They can access this URL from anywhere in the world and have instant access to their clinical data, be it—laboratory reports, radiology images, drug details or any other clinical data. This means that the patients would not need to carry their paper records anywhere as all all information would be available online. For physicians, taking decisions and offering treatment would become much simpler as they would have access to all patient data, instantly. Moreover, as the healthcare industry moves towards evidence-based medicine, the data availability because of the EHR module, would present all information specific to a particular diseases, making the process extremely simple and foolproof. Further, with computerised physician order entry (CPOE) based system in place, the job of the physician will be further simplified as they will receive continuous guidance from the system. Similarly, the decision making process for the management will become much simpler as soon as they have availability of sufficient data. The management would be able to strategise in the right direction and bring in the best class care. This would not only help them enhance the quality of services offered, but will also help in overall business growth. On the infrastructure side, with the completely modernised infrastructure in place, the chances of system failure or any sort of mishaps have almost been reduced to nil. Further automatic monitoring devices have been installed everywhere, that would immediately raise alerts in case of any problem. Dell has included a unique situation management process

Max Healthcare IT Outsourcing Project: Snapshot Phase I: Infrastructure Upgradation  Entire data centre of Max, housed in Okhla office, has been shifted to Dell facility in Noida Phase II: Building on Extensive Health Record System for Max  Based on VistA open source, it is being customised as per Indian needs  Creating records for out-patient department, which is first-of-itskind in India  Entire application to nest on MPLS cloud so any new hospital gets active once it gets connected Phase III: Building New Applications on the Robust Infrastructure Implementing 3G solutions for telemedicine and teleradiology  Creating Health Information Exchange  Patient can access all historical data by just filling password on the respective websits 

called the SitMan bridge, with which all queries and problems will get resolved in a definite period of time. With so much in place already, Dell believes that Max Healthcare is yet to realise the real benefits. At the end of the first 3-4 years,

when the optimisation phase is over, that is when Max will reap the maximum benefits from this system. According to calculations made by Max, the entire project would reduce the average time of stay of a patient in the hospital by one day. Further adding to this, reduced paper costs will help Max save around `2.5-3 crore, per year. While, the challenges for both Dell and Max have been many, this deal is expected to bring them much more than they would have expected. Max is confident that the completion of the entire project, would put them on the top as far as use of IT is concerned within a hospital environment. The deal would put Max on the roadmap for achieving their aim of becoming a world class level 7 hospital and have the right technologies to bring in a safe environment, increase accessibility of healthcare and reduce waste as much as possible. On the other hand, the deal would provide Dell Services the right learning experience in the Indian healthcare market. The biggest benefit that this would provide would be for the Indian healthcare industry is concerned by setting the trend for enhanced IT adoption and IT outsourcing by Indian hospitals.

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SPOTLIGHT

Dr Pervez Ahmed CEO & Managing Director Max Healthcare

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â&#x20AC;&#x153;The ITO Deal Has Been a Positive Learning for Usâ&#x20AC;? Dr Pervez Ahmed, a visionary and a leader in the field of healthcare, has been the guiding force behind the implementation of the IT outsourcing partnership between Max Healthcare and Dell Services. Pravin Prashant and Divya Chawla spoke to Dr Ahmed about the actualisation and implementation of IT services at Max, through this deal.

Give us an overview of Max Healthcare and its future plans in terms of growth and expansion? Max Healthcare, currently, has six hospitals and two diagnostic centres, which are all located in the national capital region, comprising of 1000 beds. We are currently in the process of building four new hospitals at Shalimar Bagh, New Delhi; Bhatinda, Mohali and Dehradun. All these hospitals will start operations between June and October 2011, after which we will add around 1200 beds and have a total of around 2000 beds. We are also open to looking at opportunities for mergers and acquisitions. In addition, we are planning to set up an educational facility, which will be on the health sciences side in Greater Noida in around 4 years from now. At the end of our horizon of growth, we expect to have around 4000 beds in another five years, most of which will be in the NCR or the Shatabdi region. We want to concentrate our growth in North India because logistically it is a more scalable model. We have three super-speciality hospitals in Delhi located in Saket, Patparganj and the upcoming hospital in Shalimar Bagh. Further, we have multi-speciality hospitals located in Gurgaon, Noida, and Pitampura. Diagnostic centres are located at Panchsheel. Max Healthcare has also partnered with Nova Medical Systems, which is an ambulatory surgical product for Northern India. We are very conscious of the quality of product that we provide. Our entry in the tertiary care is only four years old and in this short period, we have been able to reproduce scalable, consistent and high quality experiences. Once we get the formula correct in a very tight logistical area like this, we can look at opportunities for expansion and providing the same experience in other parts of the country. To be able to deliver quality care consistently, we have opted to install an Electronic Health Record (EHR), along with which comes business and Management Information System (MIS). What were the problems you were facing in your present system, which helped you move towards outsourcing? We have had a home grown Hospital Information System (HIS) for the last 5-6 years, which has been doing a fairly decent job as far as finance and accounting are concerned. However, competitive advantage to deliver quality medical care requires the integration of clinical diagnosis, procedures performed, and the expenditure and cost. The proposition is to be able to provide the highest quality care at the lowest possible cost to customers and patients. To allow customers and insurance companies to choose the highest quality clinical provider, the outcomes need to be measurable, reportable and reproducible. We, therefore, realised the need to move from a simple HIS to an EHR, which coupled on top of the HIS can give us the ability to have a true MIS and help us take strategic decisions. As the industry matures in India and we move forward towards disease management, where the focus of care would be the patient, the requirement for adequate information would be immense and that is not possible without an EHR. The increased amount of work and scope required for an IT infrastructure, was not something that we were willing to invest in as that is not our core area of operation,

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SPOTLIGHT

because of which, we looked at outsourcing. We negotiated with Perot and have outsourced them for a long term and this has worked quite well for us. The data centre migration has occurred, although with a few hiccups, but overall it has been a very clean process. We have backup for disaster recovery both at the Dell Services centre as well as at servers in our Okhla office. Hence, we are secure now, which is very important as we get more and more electronic. It has been a positive learning curve process both for Dell Services and Max Healthcare and it will be extremely beneficial in the long run.

The deal is worth `90 crore and after adding the hardware, the total IT applications for 10 years will cost us around `120 crore. If the scope of the work increases, additional expenses will be set up

How does your project benefit from the complete ecosystem, which includes management, doctors and patients? What is the RoI? In the areas of patient stay and paper saving, there is a potential benefit of about `2.5-3 crores per year. The benefits are plenty for the patients and the quality of service offered. For instance, the use of barcode system will eliminate all medication errors as all drugs bought from the pharmacy will be barcoded against the

nurse and the patient. As far as the patient benefit is concerned, after the integration process is complete, each patient will have his/her own URL, which will work through a cloud, and provide the entire clinical history. This data can only be accessed by the patient, physician and primary hospital. The patient will have to give confirmation to allow physicians within the Max network to access his/her data. Special permission will be required for personal information like the HIV status. Currently, we do not

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have the HIPAA norms, however we still use them as a baseline. As a CEO, how do you look at this project? Will this project help you in better decision making for all your activities, be it finance, business development, expansion or customer satisfaction? The business information that we are able to get out of the system, will give us an opportunity to strategically decide on the products, which we need to develop. It will also help us in growing more in terms of clinical management and business. Technology is an enabler and it is going to enable us to perform in any area in the best efficient way. If the data is easily available then the speed and efficiency to be able to implement something will be much faster. This will help the business achieve all results that it aims to achieve including financial excellence, quality excellence, and safe environment. This is a huge step as far as I am concerned, for reducing cost of healthcare and making it more efficient by eliminating the need for patients to carry paper records.

ZOOM IN

Track IT Down The application of Electronic Medical Record, if implemented at large in healthcare, will improve patient care, reduce expenses, and fundamentally change the way in which medicine is practised in the country By Sangita Ghosh De

here has always been a debate on the subject. Electronic Health Record (EHR) and Electronic Medical Record (EMR) have been the centre point of discussion in almost all major medical issues in India. There is no doubt that it has to be implemented across all the verticals of the healthcare services sector but the debate

regarding the timeline, the parameters and process of the implementation continues. The Institute of Medicine (IOM) in USA in a 1999 document entitled “To err is human” had stated that 98000 deaths occur each year in USA alone due to medication errors. EMR/EHR for each individual throughout his life span is the essential first step. IOM urged that by 2010 all prescrip-

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tions should be written electronically as it eliminates errors and coordinates better. “Medication errors occur because the prescriber does not have immediate access to relevant information relating to the patient’s condition and drugs timely,” said Dr Ramchandra Lele, Director, Nuclear Medicine, Jaslok Hospital and Research Centre, Mumbai.

ZOOM IN But the adoption of meaningful IT and EMRs has been slow all over world including US hospitals, commented Dr Sanjeev Sood, Hospital and Health Systems Administrator, SMC, Air Force Station Jodhpur. “Though no survey has been carried out on adoption of EHR/EMRs in India, but of the 15,000 hospitals, there are only a few (less than 300) that may have migrated to some form of EMRs,” he analysed. The reason behind this is that the majority of softwares running in Indian hospitals do not have a useful EMR module. Either the EMR module is too rudimentary or is so user unfriendly that it is not practical to fill it for every patient. “The incentive for entering data in an EMR is also --very low. Its benefit to an organisation is low unless it also possesses means of extracting medical data in an analysable form. Very few EMRs have been designed to store data in a very granular fashion and very few organisations have the tools to extract the entered data in an analysable form,” reviewed Dr Karanvir Singh, Head, Medical Informatics, Sir Ganga Ram Hospital (SGRH), Delhi. At a national level, unless there are medical data interchange guidelines and incentives it is unlikely that hospitals will increase spending to achieve this objective.

The size of the pie According to a recent study by Accenture, the growth rate of global EMR markets is ranging from 6.6 to 9.7% across US, Europe, Latin America and Asia Pacific. The market is slated to be worth US$ 19.7 billion in 2013. US will experience 9.7% growth in its EMR market—from US$ 7.4 billion in 2010 to US$ 9.8 billion in 2013. With 5,800 hospitals, EMR adoption is beginning to accelerate due to American Recovery and Reinvestment Act (ARRA) incentives and penalties in US. Asia Pacific’s (APAC) EMR market is expected to grow at 7.6%, Europe, Africa and Latin America will grow at 6.6% through 2013. Emerging markets, such as India and China may be a primary growth driver globally and may have the potential to implement innovative technologies, such as cloud-based EMR

solutions. Other projections predict much more rapid growth in Asia Pacific. According to Frost and Sullivan, although the APAC Health Information Technolgy (HIT) market represents currently only 2.1% of the total healthcare market, it is very likely that the figure could double if not triple that in the next 10 years. Despite the massive size and potential of the markets represent, global players hesitate about entering these markets because of some critical shortcomings in care delivery models. In India and China the number of patient attended per physician counts at 1,700 and 950 respectively, while each physician in the US is responsible for supporting only 400 patients.

Advantages of EMR/EHR are more for clinicians than for hospital administrators. While implementing, the hospitals always look for user friendly and cost effectiveness “The current market for Hospital Information System (HIS) in India is estimated around US$ 60 million. EHR/ EMR is a key component of this segment and the major driver for growth in future. The market is expected to grow at 10% per annum in future,” estimated Rahul Chatterjee, Deputy General Manager and Head, Healthcare, Siemens Information Systems, India. Siemens has recently launched its Hospital Information System (HIS), Soarian MedSuite, at the SL Raheja Hospital in Mumbai — a first-ofits-kind in India. Soarian MedSuite has an integrated Electronic Patient Record

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and addresses the administrative, clinical and financial processes of the hospital. But there are some obstacles. The advantages of stored medical data are more for clinicians than for hospital administrators. Unfortunately in most hospitals it is not the clinicians who control the budget and hence clinically useful systems do not get purchased, depicted Dr Singh at SGRH. While implementing the system, the hospitals always look for user friendly and cost effectiveness, stated Dr Param Hans Mishra, Dean, Indian Spinal Injuries Centre. International expansion remains a challenge for the companies where 71% view global markets as a growth opportunity in the short term and 100% view global markets as an opportunity in the long term, the study by Accenture depicted. Steady growth in EMR/EHR markets is expected across the US, Europe and Asia Pacific. In the US, after the enactment of ARRA in 2009, an estimated US$ 19 billion is being infused into health IT. It is estimated that 90% of all physicians and 70% of all hospitals in the US will adopt EHRs under the Health Information Technology for Economic and Clinical Health (HITECH) Act by 2019, informed Dr Sood. A prospective growth of EMR needs government incentives, urged the medical community. Australia allotted additional packages for EMR and HIT adoption for further adoption in EMR and related activities. Also there is a shortage of clinical IT specialists globally which is slowly pushing the system towards cloud-based solutions for support and maintenance that reduce costs, increase efficiency and enable redeployment of valuable resources and over one-third of global health organisations have started using it.

The Indian landscape India is still in the early stage of EMR implementation, stated Dr Singh. In 2005 SGRH implemented a HIS software along with EMR component (TrakCare, owned by InterSystems, USA). “Currently just over 50% of the admitted patients are having their medical details entered in the EMR at SGRH. This works out to about

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ZOOM IN 100 patients having EMR entries per day but not for outpatients because of heavy workload and complicated logistics issues,” he added. But EMR implementation in India needs a concrete backbone structure. “We need faster network connectivity for easy accessibility of data and quick response time, strong security, privacy and confidentiality with a secured back up prevention of loss of data, high storage capacity of servers for archiving of large volumes of data, ability to integrate and operate with legacy systems across various departments, hospitals and other systems,” clearly defined Dr Sood. The hospitals that have moved on to digital records are mainly private corporate hospitals, some trust run hospitals like SGRH, Delhi, AIMS, Kochi; and few progressive state govt hospitals on funding from State Health Projects. Since there are no standards prescribed by any Indian regulatory authority, issue of compliance of implementing EMR have not yet arose, Dr Sood informed. According to Dr Singh, compared to EMR compliance in other countries, India is behind many of the developed countries. The main difference is the availability of funding. While some medium and large hospitals fund EMR projects of their own, there is no nationwide funding for a national EMR backbone.

Roadblocks to overcome It is clear that any market is complex enough according to its own parameters and challenges to overcome for a trendy growth and EMR/EHR is no exception in that. However, a number of factors have an impact across the market. According to Dr Singh, “When we selected the HIS software we looked at the flexibility of the EMR module so as to it allows the IT department staff to make configuration changes that meet requirements of different departments.” But shortage of clinically trained IT resources will impact future markets, apprehended Accenture. Government regulation and support in funding are also key drivers of EMR adoption. Health information

Shortage of clinically trained IT resources will impact future markets of EMR, as digitising the preexisting medical records is a huge challenge exchange (HIE) is also expected to evolve with EMR. “One strong incentive for storing medical data in a computerised form is the interface with insurance companies. But in India, insurance companies have not yet started the movement of requiring medical data to be submitted to them electronically,” observed Dr Singh. He pointed out this could be a potential reason of spreading EMR in India. Digitising the preexisting medical records is a huge challenge, commented Dr Sood. “In the US and Canada, hospitals are experiencing very thin (or even negative) margins, making it a challenge to set aside funds for EMR. Recently, Australia announced a US$467 million national e-health initiative sponsored by the government to link EMR systems and HCIT applications. Conversely, in Japan many hospitals are struggling to afford ongoing EMR due to inadequate government support,” he informed. But security and data sharing is a mater of concern now. This might prevent cloud solutions from being utilised, because transmitting and sharing data with various locations and institutions is at high risk, apprehended Dr Sood. “We have

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not imported legacy data into our new HIS. The old system continued to run on another parallel server in case we needed legacy data for any patient as the older system did not maintain a unique ID for a patient and was hence incompatible with the new system’s structure,” mentioned Dr Singh. But all these include high costs which sometimes become unbearble for some institutions. The implementation gives no added revenue to hospitals, voiced Dr Mishra. There are also issues like interoperability and seamless connectivity, big-bang or incremental approach of implementation; and lack of overall policy and vision in EMR adoption in healthcare. “There are also concerns like loss of customer base by sharing patient EMRs, erosion of clinical acumen and unclear return on investment. But problems like tedious data entry, increasing of staff workloads, poor user interface, disrupted workflow, faulty connectivity, and inadequate software updates—have been gradually solved over the past decade by early adopters,” said a positive Dr Sood. But a US$ 31 million EMR at the Cedars-Sinai’s hospital, Los Angeles had to be rolled back

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ZOOM IN just after implementation because it was not user friendly, he informed. However, healthcare IT solutions have primarily focused on addressing the administrative and financial processes of hospitals, Chatterjee at Siemens addressed. “However, adoption of IT by physicians is a challenge in the healthcare sector. Healthcare providers are beginning to appreciate the role of IT in driving patient safety, quality of care and clinical outcomes,” he added. The market for EHR/EMR is already growing globally. Emerging markets have the potential for rapid growth by using innovative technologies like cloud-based solutions, Chatterjee reconfirmed.

ensuring patient

can reward and incentivise HCOs that adopt IT and EMRs with ‘meaningful use’, as done in US under HITECH Act. Further, government needs to enact suitable legislation and policies to encourage adoption of EMR, and provide guidelines to standardise the process,” added Dr Sood. While in the US, HIPAA address some of the relevant issues, much remains to be done in India. “Government incentives are expected to be a key driver for the growth, a visible trend in the US, EU and in several other countries like Australia. The government needs to come out with a set of regulatory standards to address the needs of the market to drive adoption and HIT through funding packages for regional and national integration projects,” urged Chatterjee. The already existing international standards can do the job fairly easy for the government, commented Dr Singh. Because those may be idealistic standards which can be slightly watered down to draw various models for the country.

safety, quality of care

For a healthier tomorrow

Digital medical

Ensuring data security and confidentiality

records are more

As has already been discussed data integrity and confidentiality are very important issues for any hospital. “I have found in a few hospitals while importance has been given to strong protection on data confidentiality from the user interface very little importance has been given to integrity at the hard disk level. It was possible for any user with knowledge of SQL to fire an update query and update the data stored on the hard disk,” Dr Singh commented. SGRH has addressed this issue by implementing ‘Cache Direct,’ an application that prevents access to data stored at the server level itself. Since India does not have Health Insurance Portability and Accountability Act (HIPAA) or equivalent laws, stringent control of data confidentiality is missing. “But our HIS, which is customised, password protected and fully audited, does not allow anyone to extract patient data from system in text or any other form, except in the form of valid patient reports,” assured Dr Singh. But digital medical records are more secure than the old paper records, debated Dr Sood. Furthermore, access is easily tracked and audited if ensured with the right level of security and advanced encryption codes. “The EMR data analysis software can detect duplicate payments, overpayments to Health Care Organisations (HCOs), non-billing to health insurance companies,

secure than the

old paper records,

and clinical outcomes and miscoding of diseases and payments, thus preventing fraudulence,” he further pointed out. In the developed countries, patient owns data and decides who can see it and can even prevent it from his treating physician, which is not at all possible in India with low or no literacy to manage their own data and associated rights and therefore treating doctors can see medical data without requiring patient authorisation, exemplified Dr Singh.

Government as watchdog But there is a very strong requirement for data interchange standards in India and it is only the government which can spearhead this, Dr Singh apprehended. “The reason is clear. Hospitals, by themselves do not have any incentive, and may even have a disincentive, to provide their own data outside their organisation where the partner hospitals need to adopt their software,” he clarified. “The government

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Nevertheless, cloud solutions is expected to have a significant impact, with an apprehension of increasing spending on clinical IT over the next five years. Emerging markets includes Asia Pacific countries may experience rapid growth by learning from more developed nations and utilising innovative approaches. But the development will largely depend on regulatory standards, government support and future trends affecting domestic healthcare systems, analysed research reports. Research says that the Nordics, Spain and Australia will be the global leaders in overall EMR implementation in 2013, while France, Germany and Japan are expected to be market laggards with lower rates of adoption, where the US is expected to exhibit the highest projected growth rate. According to NASSCOM, the future IT growth will be driven by healthcare sectors in short and long term. According to Dr Sood, as the volumes increase, and models like SaaS and cloud computing becomes available; the cost will come down further making IT applications affordable to all.

MY JOURNEY

Satish Kini Founder Director & Chief Mentor 21st Century Health Management Solutions Pvt Ltd

Hobbies Reading books on or by great spiritual and business leaders and writers, inspirational books and books on humour

Favourite food Home cooked Mangalorean meals and snacks, Malvani/ Goan style sea food and Chinese cuisine

Favourite holiday destination Panjim Goa

Favourite pass time Spending time with family and old friends at home or at our clubs

Find Cause, Means Follow Satish Kini’s continuing quest to find his purpose in life

realised I was wired differently, when in my 4th year at IIT Bombay, like most IITians, I got my forms for GRE exams — the shortest route to the US. After a night of introspection, I auctioned off the forms the next day. I realised my heart was more in social engineering rather than the forms of engineering taught at IITs. I completed PGDBA from JBIMS in 1981. In the early 80s, with an MBA under my belt, I looked for a job where being young and idealistic was not a liability. I also looked for a SME so that I could be close to the top. I needed

an inside view of their vision, mission and approach. Especially their approach towards business in particular and society in general. I wanted to learn the ropes of running a company properly. I also wanted an opportunity to test out my ideas and approach. My search led me to IDM in the fledgling IT industry. IDM was a small but hi profile IT solutions company founded by 170 exIBM employees. After IBM had to hastily exit Indian shores in 1978 due to restrictions imposed on MNCs. Commitment to customer and respect for individual were two of IBM’s core beliefs that IDM genuinely practiced. For

October 2010 < www.ehealthonline.org <

MY JOURNEY this, I am grateful to Dr OP Mehra, the founder MD of IDM. IDM ethos resonated well with my beliefs. IDM was like a real life business school for me to test my ideas and my holistic approach to serve customer needs and build relationships based on trust and competence. From Management Trainee to Head of Corp Strategy took me less than 7 years in IDM. But this was too good to last. After the IPO, there were rifts at IDM board level; more due to personal egos rather than business directions. Like many good things end in India, petty politics resulted in IDM being sold in 1989. It was time for me to move on. The choice was to continue going up the corporate spiral or break out. I founded Trust-House Management Consultants Pvt Ltd in 1990. We defined our management expertise. Guiding big and small companies on Business Transformation Strategies, Business Process Re-engineering, Productivity and Cost management, Customer Relationship Management, to facilitating ERP adoption through Change Management and Employee empowerment. We practiced what we preached. The 90s was a very exciting decade for me and for 7-8 young consultants/trainees at Trust House. It was very interesting to see that many of our ideas on organisation structures, business processes, roles and accountability and empowerment were incorporated in some way or other in world class ERPs. In the 90s, Indian Healthcare providers were not organised and structured enough to undertake HIS implementation in the way corporates adopted ERPs. So there was no money to be made in Healthcare IT solutions in India. Most Indian companies in IT services saw it as a hopeless business case to try and build HIS solutions for Indian Hospitals. Having seen how world class ERPs have been adapted for Indian use, I saw it as an opportunity to build world class HIS in India, incorporating best practices not only for India but for other English speaking parts of the world. At the same time, I felt this is the chance I was look-

In 2002-03, we implemented the old version of HIS in 10 Hospitals. By 2004-05 we had a list of 35 Hospitals who were using Novella HMS. All of them were going gaga about our approach which included BPR, our methodology and our HMS ing for to make a difference. This is the reason destiny had held me back in India. Not being a software specialist, I turned to my old colleague from IDM, Ravi Mani who was running a 20 man software shop. He had a deep understanding of Hospitals management issues and good experience of developing Hospital Systems. After doing 2-3 Hospitals over 5 years, he had concluded that it is not economically viable to do HIS as business. I explained to Ravi my vision of transforming Indian Healthcare through People Processes and Technology. We will create a world class HIS product out of India. Not only for India but for rest of the world. We could cross-subsidise charitable Indian Hospitals with money we get from Hospitals in Middle East. He thought I was crazy. But we had to stop all local software projects. He was panicking. I explained how we can get part funding through some small IT projects from friends in US and UK. And if it did not work out we can always go back to what we were doing earlier. He was just 38 and I was 48. I must have been talking excitedly like that mad guy on Dadar bridge. Surprisingly, he agreed and we merged our two companies in 2001 to form Novella HMS.

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At my first meeting with his team software specialists, I presented them with our vision and the fact that we are planning to focus only on Hospitals. I told them that we aim to sign up complete 10 Hospitals in first year with our existing HIS product. There was pin drop silence. Their eyes told me that they too thought I was crazy. In 2002-03, we implemented the old version of HIS in 10 Hospitals. By 2004-5 we had a list of 35 Hospitals who were using Novella HMS. And all of them were going gaga about our approach which included BPR, our methodology and our HMS. And above all our people — who they said were very committed, very competent and very empowered. On Republic Day in 2005, we had an excited gathering, where I presented the idea of unified 21st Century Health Solutions co which can convert our dream to reality. Everybody thought we were all crazy but everybody also agreed that we have to be a bit crazy to attempt such huge challenges. 21st Century Health Management Solutions Pvt Ltd was formed in May 2005 adopting Dr APJ Kalam’s Vision of “ Healthcare for All by 2020” and also the following inspiring thoughts — “Find Cause, Means Follow” by Mahatma Gandhi and “There is nothing impossible that a small group of people cannot achieve. In fact, that is the only way to achieve the impossible” by Margaret Mead. Today 5 years later, 21CHMS and its 150+ Centurions are most respected for our Healthcare Consulting and Healthcare Informatics solutions. Our services and solutions are helping the biggest and the best of Hospitals, Diagnostics Centres, Pathlogy Labs and Clinics to make Healthcare Services Patient Sensitive, Accessible, Accountable and Affordable. We currently support over 350-400 sites in India, Middle East, Africa. By end of this year we expect a big breakthrough in Europe. But we have miles to go before we can achieve our goal of “Healthcare for All by 2020”.

TECH TRENDS

The New Age Health ‘Experts’ By Dr Bhupinder Chaudhary, Baljit Saini and Rishu Gupta

xpert systems are a branch of Artificial Intelligence or ‘AI’, which also includes robotics, natural language processing, and other applications. Such systems can be defined as a collection of hardware, software, data, and embedded knowledge that demonstrates characteristics of intelligence. Although, the medical profession and healthcare management have historically lagged behind industry in the use of expert systems and decision support, yet, theses applications can save countless lives, not to mention hundreds of billions of unnecessary expense Although, expert decision-support systems in medical diagnosis and treatment have been around since the 1960’s, they have remained until recently an academic exercise, waiting desperately, for the medical and health professions to reach out and apply them. There are three main relevant classes of information to be accessed by physicians when trying to reach a decision concerning a medical case namely expert’s

In the health sector, there is a need for a computer based system, which not only asks relevant questions to the patients but also aids the physician by giving a set of possible diseases from the symptoms obtained using logic at inference. Expert systems or knowledgebased systems use computer programs that contain some of the subject-specific knowledge of one or more experts

October 2010 < www.ehealthonline.org <

TECH TRENDS opinion, colleague’s opinion and medical literature. The expert opinion is necessary in medical decision making, since there are wide variations in clinical practices. Moreover, the growing need to assess and improve quality of healthcare has brought to light the possibility of developing and implementing clinical practice guidelines based on expert opinions. Even though a colleague’s opinion helps in accessing information about real cases, which is another important source of information, an important goal to reach when dealing with real medical cases is to have simultaneous access to an expert’s opinion about the same indications of the real case being treated. The increase of the information volume in each medical field, due to the emergence of new discoveries, treatments, medicines and technologies, leads to a frequent need of consulting medical literature and in particular specialised journals. Certainly, due to the huge volume of this information, a classified, targetted, access is necessary.

assist to diagnose and treat blood diseases. MYCIN was the pioneer in demonstrating how a system can be used to successfully perform medical diagnosis. Another early expert system is the PACE (Patient Care Expert System), which was conceived in 1977 with the purpose to make ‘intelligent selections’ from the overwhelming and ever changing information related to health in order to facilitate patient care. The system started off as an educational system for the nursing profession. Throughout the years, the system evolved and went through many development generations to a point where it became

Fucntioning

an advanced clinical management system capable of supporting the entire health care field to diagnose and care for patients with pulmonary diseases. Another expert system called, MITIS system, was developed in 2004 at the National Technical University of Athens. The MITIS system was developed to assist in the management and processing of obstetrical, gynaecological, and radiological medical data. The concept behind this system is to record and store information from experts in medical departments of gynaecology, radiology and obstetrics to provide a centralised mechanism for managing patient information within and outside a hospital.

sentation of knowledge. If the knowledge is represented in the form of rules then such systems are called rule-based expert systems. Different techniques have been developed for knowledge acquisition. The interaction with the expert system is made through user interface. The interaction is performed through an interactive dialog. The knowledge base is the heart of an expert system. Typically the knowledge base is in the form of if-then rules. The inference engine finds a sequence in which inferences are made. The inference engine is used to reason with the knowledge base. In forward chaining rule-based systems case specific data is also called working memory. The working memory contains the result

Systems are computer programs that are meant to solve real world problems. In normal routine, these problems are solved by domain experts. Thus, the knowledge has to be extracted from the domain expert in order to develop an expert system. Extracting the knowledge from a domain expert and to convert it into a computer program is a difficult task. This task of extracting the knowledge from a domain expert is performed by a knowledge engineer. The knowledge engineer provides useful assistance to domain experts in determining the repre-

The background The application of IT research and development to support health and medicine is an emerging research area with significant potential. Major initiatives to improve the quality, accuracy and timeliness of healthcare data and information delivery are emerging all over the world. The Agency for Healthcare Research and Quality (AHRQ), of the US Department of Health Services (HHS), awarded grants and contracts to promote the use of health information technology. Computerised systems including expert systems have been used to carry out efficient and effective data processing on complex problems to support various problem domains since the 1970’s. Since the advent of artificial intelligence in the 1970’s that saw the birth of expert systems, various domains have taken advantage of this technology. The most popular application has been in the area of health and medicine. MYCIN developed in 1970 at the Stanford University, is one of the most popular medical expert system used to

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Knowledge Base End User User Interface

Inference Engine

Answers

Keywords

Components of an Expert System

of inference process. Expert systems also facilitate the users by providing explanation subsystem. The explanation subsystem explains its reasoning to the users. Knowledge base editor is provided in some systems for writing and updating the knowledge base. Expert systems have the ability to separate problem specific knowledge from general purpose reasoning. This general purpose block without any domain specific knowledge is called skeletal systems, or expert system shells. Many commercial shells are available these days. Thus expert systems are a combination of expert system shell and domain specific knowledge. Expert system software programs consist of large databases of information with various components integrated into a software package. Software programs include partitioned and cataloged information for user access. Databases in the software contain health care information by separating data into knowledge-based components.

Components User Interface: Description of a problem is entered through user interface. Inference Engine: Inference engine is a generic control mechanism that applies the axiomatic knowledge in the knowledge base to the task-specific data to arrive at some solution or conclusion. Knowledge Base: The knowledge base constitutes the problem-solving rules, facts, or intuition that a human expert might use in solving problems in a given problem domain. The knowledge base is usually stored in terms of ifâ&#x20AC;&#x201C;then rules.

Constructing medical expert systems Medical expert systems can be constructed either through AI languages or from expert systems shells. Expert system shells provide more general facilities and an easy way to enter necessary knowledge about the problem domain. ESTA, EXSYS, XpertRule, ACQUIRE, FLEX etc. are some of the popular Software packages used in the construction of medical expert systems. LISP and PROLOG are two famous AI languages used to develop medical expert systems.

of new diseases and their treatment. ICD-10 codes will have the ability to take on the latest advancements in modern medicine and have the room and flexibility needed to allow for future healthcare advancements. The ICD is used world-wide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine. This system has been designed to promote international compatibility in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO. The ICD is revised periodically by WHO and is currently in its tenth edition. The ICD is a core classification of the WHO-FIC. The ICD-10, as it is therefore known, was developed in 1992 to track mortality statistics. ICD-11 is planned for 2011 and has become the most widely used statistical classification system in the world.

About the Authors

Statistical classification The International Classification of Diseases is published by the World Health Organisation (WHO). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. One of the main benefits of upgrading to ICD-10 codes is that it will finally allow the United Stateâ&#x20AC;&#x2122;s healthcare data to be compatible with the rest of the developed world. In addition, implementing ICD-10 diagnosis codes will allow for more accurate and complete documentation of patient diagnosis and care. The thirty year old ICD-9 diagnosis codes have reached the limits of their effectiveness and are no longer capable of taking into account the advancements in patient care, advent of new technology and manifestations

Dr. Bhupinder Chaudhary Assistant Professor, Department of Hospital Management, HNG University, Patan (Gujarat)

Baljit Saini Lecturer (CSE) SBBSIET, Khiala, Jalandhar (Punjab)

Rishu Gupta Lecturer (Management) SBBSIET, Khiala, Jalandhar (Punjab)

October 2010 < www.ehealthonline.org <

APPLICATIONS

Counting on Data Smarter decisions always yield a better outcome. The article gives a picture where leveraging data analytics in healthcare has Dr Sanjeev Sood Hospital and Health Systems Administrator, SMC, Air Force Station Jodhpur

t is said that as a general rule, the most successful organisation today is the one with the best information and knowledge. In recent years, breakthroughs in data-capturing technologies, data standards, data warehousing and data mining, health management information systems (HMIS) and modelling and optimisation sciences have created opportunities for large-scale analytics programs. Several health care organisations in the private sector have not only leveraged fact based decision making, but also created sustained competitive advantage from data-based analytics. They have their business strategies at least in part-around their analytical capabilities. In a recently concluded 6th International eHealth Conference in Hyderabad, organised by CSDMS and ELETS, importance of quality data management, data warehousing, data mining and analytics was repeatedly emphasised by various speakers during the sessions, ‘Transform, Perform

now become obvious and therefore, aims at ensuring business intellegence for the sector in near future

and Reform-Charting blueprint for the future of health care’ and ‘Hospital CIOs’ Conclave. IBM Centre for The Business for Government had also set up an exhibition stall on ‘Strategic use of Analysis’.

What is behind the name? Data Analytics can be defined as the science of extensive use of data, statistical and quantitative analysis, explanatoryand predictive models, and fact-based management to drive decisions andactions. Analytics is a subset of what has come to be called business intelligence: a set of technologies and processes that use data to understand and analyse business performance. In health care organisations, managers and physicians often base their most decisions on experience, intuition, unreasoned assumptions or memory rather than on scientific evidence and analytics. Analytics and fact based decision making can make just as much or even more of a powerful contribution to the

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achievements of governmental missions as they can to the accomplishment of corporate business objectives.

Role in healthcare The use of analytics is also gaining popularity due to availability of several software such as Minitab, SPSS and Epi_Info and statistical tools in spreadsheets, to more complex business intelligence suites, predictive applicators and the reporting and analytic models of major enterprise systems. So far, the health information and analytics have been extensively used in healthcare to measure health status of the population, to assess their health problems, for making comparisons for health status, for planning and administration of quality health services and for carrying out scientific research. More recently, the data has been increasingly used by health care organisations as a part of Business Intelligence, to make strategic decisions and

Health information and analytics have been extensively used to measure health status globally

choices, and to gain competitive advantage in market. Today, analytic strategy is viewed as a key engine of a dynamic capability of an organisation.

health problems. Currently, most Indian HCOs are data poor; some are data rich, but information poor; very few could be data and information rich.

Basics first

Assessing capacity

Most Indian Health Care Organisations are yet to embark on analytics journey or are still in early stages of it. The Indian health care organisations need to generate and compile good quality data by structured and reliable reports and returns from multiple sources. This data needs to be transformed into intelligence to guide decision and policy makers, administrators and health care personnel. Certain hospitals, which have moved to EMRs, have already begun to deep archive their data into warehouses, so as to subsequently use it for research, mining and subject it to analytics to make smarter decisions and improve quality of care. As of now, availability of quality data on morbidity patterns and patient safety are grossly inadequate in India, so as to design innovative health insurance products for population and institutionalise effective patient safety programmes in hospitals. We have been drawing inferences from US data and applying to our

Data: The data should be discrete, granular, reliable, and clean and standardised across the health care organisations. Enterprise: An enterprise approach to analytics implies that organisations work across functions in a unified manner rather than fragmented nature of information held in disparate silos. Leadership: The leadership should be committed to use analytic tools and techniques to achieve strategic goals. Target: The healthcare organisations must have a long term strategic target with a broad based strategic intent followed by analytics focused strategy. Analysts: The healthcare organisations must have analytic talent, either in house, or consultants to provide continuous high quality advice.

Applications in healthcare Analytics is increasingly important in healthcare and find applications in diverse

situations. In practicing of evidence based medicine and adhering to online clinical protocols need serious data managment and analysis. The Department of Veterans Affairs is currently using this approach extensively. Performance and outcome measurement based on integrated health information systems also needs data interpretation. Many private hospitals in India too have developed their in house quality management programmes based on data analytics. Capacity management is among hospitalsâ&#x20AC;&#x2122; key challenges. When hospitals do not successfully manage capacity assets, they suffer by way of revenue loss, operational inefficiency, delay and patient dissatisfaction. Advanced Analytics can impact the way hospitals manage their capacity and other processes by enabling forecasting and scheduling for the immediate and longer term. Another desirable attribute is the ability to predict each patientâ&#x20AC;&#x2122;s pathway within hospital. Hospitals seeking to acquire an Advanced Analytics solution would do well to bear these factors in mind. Situations like early detection of emerging disease vectors, spotting outbreak of epidemic and prevention of fraudulent health insurance claims also depend on data analysis. Conditions like to indentify the patient most at risk for chronic disease and high cost diseases such as diabetes and congestive heart failure and implementation of effective chronic disease management programme demands the same. Inventory management programmes and supply chain management, disease analysis, forecasting of demand for medical items and RFID or bar-coding technology to prevent spurious drugs can also become effective . Besides, decisions such as buy or outsource, underwriting for an expensive biomedical equipment like MRI, Digital radiology, brain suite and PET scan needs clarity. Best marketing strategies, holding medical camps or advertising, resources spent in finance and accounts, activity based costing, multiple regression analysis, transportation, replacement and assign-

October 2010 < www.ehealthonline.org <

APPLICATIONS lets hospital identify safety concerns, learn about successful approaches, develop and initiate solutions, and perform regular safety assessments based on data analytics.

Availability of quality data on morbidity patterns and patient safety are grossly inadequate in India, to design innovative health insurance products and effective patient safety programmes ment models to refine processes can be well assessed through data analysis.

Case reports National Rural Health Mission National Rural Health Mission (NRHM), a flagship program under Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), has launched its â&#x20AC;&#x2DC;Health Statistics Information Portal,â&#x20AC;&#x2122; a web-based health management information system, a one-stop-site that will facilitate quick and efficient flow of information starting from the facility-level, up to the district, state and finally the centre. On top of all this, the system will provide an array of intelligent tools for advanced data analytics, robust data warehousing, reporting, monitoring, evaluation and overall program management. Apllo Group of Hospitals Each of the hospitals in the Apollo group tracks infection control parameters month after month and these are benchmarked with standards and variations and values are thoroughly analysed. Periodically clinical studies on infection control, pathogens and other related areas are also carried out. All infection control parameters are tracked

as part of the ACE 25 clinical excellence initiative of Apollo hospitals where key quality parameters of each hospital in the Apollo group are entered on an online dashboard, scored and reviewed by the highest leadership of the group each month. Sir Ganga Ram Hospital Sir Ganga Ram Hospital (SGRH), a pioneer in health informatics, has been using data mining with SpeedMiner, a data mining software product by Hesper. SpeedMiner was installed as an adjunct to HIS at SGRH two years ago and has proved to be an effective business intelligence tool which helps in data dnalytics and real time monitoring of the Key Performance Indicators (KPI), query handling , and serves as a quality dashboard through the various data collated over a period of time under specific heads. Johns Hopkins Johns Hopkins has created the Comprehensive Unit-Based Safety Program (CUSP) model, which supports local efforts to reduce hospital acquired infections and complications, and also improves nurse and physician satisfaction. CUSP

> www.ehealthonline.org > October 2010

National Health Service, UK The United Kingdomâ&#x20AC;&#x2122;s (UK) National Health Service (NHS) is funded through general tax revenues. The funds are dispersed to about 105 different local health authorities, amounting to annual funding for approximately US$ 35 billion. With such a large sum of national funds going to such an important area, the decisionmaking process to justly allocate funds can be difficult indeed. An expert team from York University spent 14 months studying the problem and developed a decision-making model, identifying key variables to explain health care needs and usage in UK. This analytics based model allocates resources more justly and fairly to the genuinely needy. Manila Health Centre In Manila Health Centre, whose drug supply to patients afflicted with category one tuberculosis was not being efficiently allocated to its 45 regional health centres. Researchers at the Mapka Institute of Technology set out to create a model. The goal programming model successfully dealt with all of these goals and raised the TB cure rate to 88%, a 13% improvement in drug allocation over the previous distribution approach. This means that 335 lives per year were saved through this thoughtful use of goal programming. Data analytics focuses on inference, the process of deriving a conclusion based solely on scientific knowledge and facts At a time when health organisations are operating in an competitive enviro ment and want to wring value for every penny spent, data analytics will provide them with the strong foundation and confidence they need to excel with minimised risk. Today, analytic strategy is viewed as a key engine of a d namic capability of an organisation. Indian HCOs need to generate quality data first and then analyse this for strategic decisions and research.

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IN CONVERSATION

While the use of IT within healthcare delivery organisations has been limited in the country, technology providers like Oracle are passionate about raising awareness about the benefits of IT among these organisations. In conversation with Divya Chawla from eHEALTH, Dr Mehdi Khaled talks about the key aspects of the healthcare IT market in India and Oracle’s presence in this space.

Dr Mehdi Khaled Vice President, Healthcare and Life Sciences Asia Pacific and Japan Oracle Corporation

“IT is a Necessary Management Tool for Hospitals” October 2010 < www.ehealthonline.org <

IN CONVERSATION What is your perspective on the growing healthcare IT market in India vis-a-vis the global market? Public healthcare in India has urgent priorities to tackle, such as infrastructure, access and affordability of healthcare, health insurance coverage, and care consistency and coordination, especially for the chronically ill. In all these areas IT can add a tremendous value and directly contribute to efficiently manage the care delivery process in a transparent way. States in India are at very different maturity levels in terms of quality of care. The more sophisticated states, such as Andhra Pradesh, Uttar Pradesh and Assam are already considering health IT as a cornerstone of their overall healthcare reform strategy. However, the real growth is more palpable in the private healthcare sector thanks to organic growth of hospitals like Apollo and inorganic ones even outside of India such as the recent acquisition of 23.9% shares of the Singapore-based Parkway Group, through Fortis Healthcare. The scale of growth of the private healthcare sector in India is unprecedented globally and will be further accelerated by the rapid uptake of private insurance by Indian citizens. Increased private insurance uptake also means a decrease of burden on public institutions; however, two questions remain unanswered: will private hospitals keep up with the increasing demand without affecting the quality of their medical services? And will the government take the opportunity of decreased patient volume to redistribute medical resources and coordinate public care more effectively? What are the key opportunities and challenges that health IT solution providers face in the Indian market? In public healthcare: “Health for All” is an Indian government initiative that has been in place since 1995. However, since then, very little has been achieved and

moreover, sufficient investment in health IT to effectively enable this program has not yet occurred. Despite or because of the huge healthcare market in India (perhaps because of its size), the number one issue remains about being able to find good hospital managers who can keep profitability, quality of care and patient satisfaction well balanced. Today, there’s evidence that IT is a necessary management tool for hospitals. For example, real time analytics capabilities can help the management spot and address negative trends occurring in patient care with a lower impact on their bottom line and patient safety. ‘Build v/s buy’ remains another issue quite specific to the Indian healthcare market. There’s very little transparency from the healthcare providers in general on whether in-house software has been successful (financially or professionally), and whether the resources necessary to keep an in-house software factory defo-

How does Oracle support a large number of ISVs with its HIS solutions? We are a proud supporter of the Integrating the Healthcare Enterprise initiative. Today, Oracle provides state-of-the-art open source technology supporting all health-IT standards like HL7 and DICOM. This standards-based approach enables a seamless integration of any clinical IT solution supporting the same standards. Put it another way, we don’t create electronic medical records (EMRs), but seek to make EMRs work better. How does Oracle’s eHR solution in HTB (Healthcare Transaction Base) arena provide for secure transfer and sharing of patient data for purposes of treatment and trend analysis? Oracle Healthcare Transaction Base (Oracle HTB) is the foundation of a healthcare information exchange plat-

“Oracle offers healthcare-specific applications that help ensure quality care and decrease patient safety concerns through the integration of clinical data and the ability to analyse patientspecific information” cuses these organisations from their core business of providing medical services. As a healthcare technology solutions provider, we can play an active role in helping educate and demonstrate an evidence-based approach to showing the value of proposed solutions, ultimately equipping our healthcare customers with the capabilities to become more diligent and responsible with regards to the interest of their customers, which can be literally a matter of life or death. On a broader level, it is also important to look at the issues from healthcare providers’ perspective. These encompass the complex effects of globalisation, opaque healthcare costs and continuing industry consolidation.

> www.ehealthonline.org > October 2010

form for supporting the integration and operation of a full spectrum of healthcare applications. It seeks to help healthcare organisations increase the quality of its patient data, improve enterprise cost efficiency, and sustain system flexibility. In effect, leaders at all ends of the healthcare organisation gain a single source of truth for effective decision-making. Using the techniques of semantic normalisation and data aggregation, Oracle Healthcare Transaction Base ‘unlocks’ data from transactional systems. The platform provides a complete, centralised, and normalised data source for viewing data via a portal or other healthcare applications. It also serves as a robust platform for developing data entry applications, help-

ing healthcare organizations to improve outcomes and reduce enterprise costs. How does Oracle support DICOM standards in Oracle Database 11g onwards? Oracle Database 11g with DICOM support, is a high performing, low cost, and functionally-complete platform for large repositories and archives of Medical and Life Science images. With comprehensive support for the DICOM standard, Oracle Database can understand all the standard metadata tags and private tags in DICOM images (e.g. chest X-rays, mammograms, CT Scans, MRIs). Any search mechanism in the database can be used to search the metadata. Using optional semantic features in Oracle Database, the information in the metadata can be further enhanced with domain expert knowledge specified in what are known as ontologies. These allow queries about relationships among concepts in healthcare. A concept, such as â&#x20AC;&#x2DC;flu like symptomsâ&#x20AC;&#x2122;, may

encompass fever, cough, symptom causing viruses, bronchitis, etc. Oracle Database has semantic technology support to process such ontologies and link them with data from DICOM metadata to automatically identify all chest X-rays of people with the specific symptoms described in this example. The advantages of using Oracle Database to build large, high performance repositories and archives for medical and life science content include the integration of medical images with patient data to avoid scattering of patient-centric health records across heterogeneous systems; data transfer and sharing of medical and life science content without custom-built infrastructure; consistent enforcement of privacy and security policies for all archive content; and management of an esvolving DICOM archive (incorporation of new modalities, new DICOM standards) with no application changes or downtime. Oracle Database 11g has two features that enable customers to build large, high

performance repositories and / or archives of medical and life science content that are managed and secured using Oracle Databaseâ&#x20AC;&#x201D;Oracle Multimedia and Oracle SecureFiles. Oracle Multimedia provides full support for DICOM (Digital Imaging and Communications in Medicine), the format universally recognised as the standard for medical imaging. Applications can now use Oracle Multimedia DICOM Java and PL/SQL APIs to store, manage, and manipulate DICOM content. Oracle SecureFiles is specifically engineered to deliver high performance and scalability for storing file data compared to that of traditional file systems while retaining the advantages of Oracle Database storage. With SecureFiles, Oracle has introduced numerous architectural enhancements for greatly improved performance and scalability, efficient storage and easier manageability. SecureFiles features include encryption, intelligent pre-fetching, new network layer, file system-like logging and deduplication.

October 2010 < www.ehealthonline.org <

EVENT REPORT

The 4th International CII Health Insurance Summit 2010 was focussed on drafting policies for the futuristic industry development that is poised to grow in the country

Tax Benefit for Employee Health Cover? By Sangita Ghosh De

he 4th International CII Health Insurance Summit 2010, a two day event held during 9th and 10th of September in Delhi, one of the largest health insurance events in India, was a booster dose and pathfinder for the insurance industry particularly serving in the field of healthcare service providers. The focus of this year was on ‘Health Insurance: collaborating to build a foundation for growth and sustainability,’ apt at a time of significant developments in the health insurance industry in India. The summit was inaugurated by Montek Singh Ahluwalia, Deputy Chairman, Planning Commission along with J Hari Narayan, Chairman, Insurance Regulatory Development Authority (IRDA) and attended by over 500 delegates from across the verticals of healthcare and insurance service providers including the industry leaders, experts and stalwarts in the domain. The final report on ‘Bridging the payer-provider continuum’ prepared by the CII working groups on health insurance was also launched during the inaugural session. This report disseminates best practices and outlines mechanisms to increase innovations in products and client services including innovations that can help hospitals and insurers deliver better choices

> www.ehealthonline.org > October 2010

and services to the consumers. It also provides the outline of a comprehensive communication and awareness exercise which the industry is planning on undertaking. Such initiatives will help all the stakeholders to prepare for significant growth and will ensure that the growth is sustainable and inclusive. Health Insurance coverage should be made mandatory for organised sector employees in order to help spread the reach of insurance products, along with incentives to employers providing heath cover, stated Ahluwalia in his inaugural speech in the summit that inspired the industry as a whole. One of incentives could be providing exemption to the part contribution of health insurance premium for employees by employer. “I think the government needs to give very serious consideration to make it mandatory for employers to get group insurance for their workers. We will never be able to spread health insurance unless an element of incentive-cum-compulsion is introduced. This incentive may come in the form of tax benefits to the corporates providing health insurance benefit to their employees,” argued Ahluwalia. Besides, the issues of the stakeholders should be resolved and that too in terms of regulatory concerns for Health Insurers

who have been in financial stress past few years, assured Hari Narayan in his speech. “In India the penetration of health insurance is low and the government should seriously consider increasing its spending on healthcare,” he highlighted. Amongst the invited dignitaries Dr Prathap C Reddy, Chairman, Apollo Hospitals, Dr Naresh Trehan, Chairman, Medanta, Analjit Singh, Chairman,Max India and Bhargav Dasgupta, MD and CEO, ICICI Lombard shared their views on Health Insurance. While health insurance is growing 25% per annum and is poised to touch the landmark of `10,000 crore in annual premium soon, it is an industry struggling to be profitable while trying to grapple with growth. For most general insurers, health insurance is now the second largest line of business, accounting for more than 20% of revenue. Although all the business segments, retail, group and social are growing; most insurers loose money on the group portfolio due to aggressive competition amongst the insurers, concerned the summit. Discussion on Rashtriya Swasthaya Bima Yojna (RSBY) and Arogyasri attracted the international attendees as to how until uncovered population are covered in the health insurance scheme. Currently about 200 million people in India have medical benefits under schemes for government employees, railways, armed forces personnel and through ESIS, RSBY and Arogyasri as well as private health insurance. The total may well double to 400 million by 2015 and that the time is right for the government to define the role of health insurance in a unified national health policy, felt the industry. Eminent speakers on the first day were S L Mohan, General Insurance Council, S B Mathur, Life Insurance Council, Girish Rao, Nova Medical Centers, Antony Jacob, Apollo Munich Health Insurance, Dr Damien Marmion, Max Bupa Health Insurance, Dr David Muiry, Swiss Re, (London), Dr Jonathan T Kolstad, University of Pennsylvania, George Neale, Australian Health, AlanWatts, Reinsurance Group of

“We will never be able to spread health insurance unless an element of incentive-cumcompulsion is introduced. This incentive may come in the form of tax benefits to the corporates and I think the government needs to give very serious consideration to make it mandatory”

America, Dr R K Kaul, Oriental Insurance, Bhavdeep Singh, Fortis Healthcare, KG Krishnamoorthy Rao, Future Generali India Insurance, Peter Akers, Munich Re Insurance, Shashwat Sharma, KPMG, Segar SampathKumar, The New India Assurance Company, Jerry La Forgia and Dr Somil Nagpal, The World Bank, Dr Dinesh Arora, NRHM, Kerala, G Kumar Naik, Vajpayee Arogyashri, Karnataka, Dr A K Singla, Apka Swasthya Bima Yojana, Delhi, Sanjay Dutta, ICICI Lombard and Dr Nishant Jain, of GTZ. The second day of the summit had important discussions on the subject of reforming group health insurance, on group cover pricing and the best practices in the industry on the issue. The next session on ‘Increasing confidence in health insurance’ discussed on mechanisms to strengthen the interaction between individual insurers and consu ers and how the whole health insurance industry can engage various entities including consumer groups and media to create a more comprehensive understanding of the benefits and processes of health insurance. The summit also discussed on the role of various industry enablers ranging from data publications to transactional platforms to standards and legislative policies.

Montek Singh Ahluwalia Deputy Chairman Planning Commission

The eminent speakers on the second day were G Srinivasan, The United India Insurance, Krishnan Ramachandran, Apollo Munich, Amy Laverock, Mercer (Singapore), M Srikanth Charan, IFFCO-Tokio General Insurance, H Srinivasan, Star Health and Allied Insurance, Bejon Misra, Consumer Activist, Prof Ravi Chandran, IIM Indore, Anuj Gulati, Religare Health, Soumitra Sen, DDB India, Shivinder Mohan Singh, Fortis Healthcare, Dr Ashoke Bhattacharjya, Johnson & Johnson, USA, A P V Reddy, Family Health Plan (TPA), Dr Shreeraj Deshpande, Future Generali India Insurance, Luke Rajkumar, L&T Infotech Insurance, Alam Singh, Milliman, Madhu Aravind, HealthHiway, Dr Pervez Ahmed, Max Healthcare, and M R madoss, The New India Assurance. The summit had a final cut with the closing session on ‘Discussion with CEO’s; collaborating and dialogue, the way forward,’ that was moderated by Manvi Dhillon, Resident Editor, NDTV. The session discussed on key industry goals for the short and the medium term and how they can be achieved. New initiatives to develop closer ties between the health insurance industry and the Government of India as well as international health insurance industry associations were also explored in the session.

October 2010 < www.ehealthonline.org <

NEWS REVIEW

‘Healthy mother, healthy child’ seems to be becoming a reality Coverage Evaluation Survey 2009 (CES2009) conducted between November 2009 and January 2010 by UNICEF showed that important parameters of maternal health, such as institutional delivery, safe delivery by skilled birth attendants and mothers undergoing three or more ante-natal check-ups, have increased impressively from the time of national family health survey-III (NFHS-III) conducted during 2005-06. Institutional deliveries increased from 40.7% to 72.9%, safe deliveries by skilled birth attendants from 48.2% to 76% and number of mothers who having three or

more ante-natal check-ups from 50.7% to 68.7%. States often perceived to be backward also showed massive growth. Institutional deliveries increased from 29.7% to 81% in Madhya Pradesh, 38.8% to 75.5% in Orissa, 32.2% to 70.4% in Rajasthan, 22% to 48.3% in Bihar, 15.7% to 44.9% in Chhattisgarh and 22% to 62.1% in Uttar Pradesh. Child health indicators also improved considerably from NFHSIII. The percentage of children with diarrhoea in the last two weeks who received ORS increased from 26 to 53.6. Similarly, 82.6% children with

Collaboration for Research

Accenture and ICRI enter strategic partnership, launch programme in Pharmacovigilance Accenture and the Institute of Clinical Research in India (ICRI) had announced jointly to develop a Pharmacovigilance and clinical research programme customised to meet the growing industry requirements of the thriving sector. Titled as ‘Post Graduate Diploma in Clinical Research and Pharmacovigilance,’ the programme curriculum will span over a period of 6 to 12 months or an aggregate of 360 hours. The content of the course covers four essential modules: Basics of Clinical research, Pharmacology, Pharmacovigilance and Regulations; Case Processing; Aggregate Report; Risk Management in Pharmacovigilance & Signal Detection. Accenture will lend its expertise in terms of training the trainer, curriculum content development, curriculum execution and delivery through periodical guest lectures, periodic certification and reassessment of trainers based on predefined standards to ensure consistent quality of training and up gradation of course content as per industry requirements.

> www.ehealthonline.org > October 2010

acute respiratory infections were given advice or treatment in CES 2009 as compared to 69% in NFHS III. The percentage of children breast fed within an hour of delivery increased from 24.5 to 33.5. Full immunisation coverage at the national level too jumped from 43.5% to 61%. Of the 23 states that have shown improvement in this area, the coverage grew by 20-30% in nine, while it grew by 10-20% in six states. Large states such as Uttar Pradesh, Rajasthan, Jharkhand, Bihar, Assam, Karnataka and Maharashtra shown improvement in full immunisation coverage by more than 15%.

Policy Watch

National Program For Prevention and Control of Deafness launched National Program for Prevention and Control of Deafness (NPPCD) was launched in Maharashtra by Suresh H Shetty, Minister of Public Health and Family Welfare, Government of Maharshtra. In his inaugural speech, the minister said that Government of India has made a positive step by initiating National Program for Prevention and Control of Deafness (NPPCD). The problems caused by deafness in the community cannot be ignored. In fact there are over 25,000 children born deaf every year, whereas 75% of the problem is solved if deafness can be prevented. Treatment of deafness is expensive in terms of diagnosis, fitment of hearing aids and cochlear implant. However it is important to start the program by reaching out to villages of 8 districts of Maharashtra. Gradually all the other districts of Maharashtra can be covered. Primary Health Centers, Rural Health Centers, District Hospitals and Medical Colleges in the state of Maharashtra would be equipped to initiate National Program for Prevention and Control of Deafness (NPPCD). Audiologists and Speech Pathologists would be appointed on contract basis in the district hospitals to provide secondary and tertiary care for the identified deaf in the community.

NEWS REVIEW

In next five years 500 medical colleges needs to be set up, MCI to Government There is an urgent need for atleast 500 medical colleges in India and that too in the next five years, urged the Medical Council of India (MCI) and these new medical colleges can be established now with a minimum requirement of only 10 acres of land and admitting more than 250 students instead of the earlier regulation of minimum 25 acres of land and admission of 200 students every year. According to Shiv Kumar Sarin, Chairperson , MCI, the council has urged the government to look into the matter of setting up medical colleges instead of only leaving it to the private sector to come up with proposals. The council also recommends of changing the student to bed ratio in collegiate hospitals to 1:5 from 1:8 and for smaller cities the hospital should be built within 5 km radius of the college. As of now, there are 35,000 medical seats and 314 medical colleges and if the proposed regulations are followed, 8,000-10,000 more medical graduates would added annually.

The First Symposium on Healthcare IT Standards from HL7 India October 28 â&#x20AC;&#x201C; 30, 2010, Bengaluru HL7 India is an independent, non-profitdistributing, membership based organization that encourages the adoption of standards for healthcare ICT within India. The objective of HL7 India is to support the development, promotion, implementation of HL7 standards and specifications in a way that addresses the concerns of healthcare organizations, health professionals and healthcare software suppliers in India. HL7 India is the accredited International Affiliate of Health Level Seven International for India.

HL7 India is happy to inform you that an international symposium for spreading awareness of HL7 Standards will be held, under the aegis of HL7 India, twice every year in various places in India. This premier event will bring together key professionals spread across varied domains like Healthcare Information Technology professionals, Service engineers and Healthcare delivery personnel. The details are available at : http://hl7india.org/Education.html Contact: Education@HL7India.org

Registration Fees: Rs. 15,000/= per head (Ordinary) Rs. 14,000/= per head (HL7 India members)

Probable Speakers: Gora Datta

Mark Shafarman Chris Lynton-Moll Supten Sarbadhikari

Technology Media Partner:

October 2010 < www.ehealthonline.org <

NEWS REVIEW

CII-GOI join hands for skilled workers in healthcare To increase the number of skilled workers in healthcare, the Confederation of Indian Industry (CII) is working with the health department to train school dropouts to work in hospitals and for homecare. According to the newhealthcare panel of the new project there are not enough trained people to work in hospitals as ward boys or offer care at people’s homes. But after a sixmonth course along with an internship at a hospital, the new curriculum can also train them to draw blood samples. The CII would work with the government to upgrade PHCs under private-public partnership models. The new course will also look into the certification for those working in fitness, beauty, rejuvenation, nutrition and counselling as they are important to attract tourists. Moreover, services in areas like rehabilitation therapy and counseling would also be included to meet the local requirements.

Health Research

Indian household spends 7% of total expenditure on healthcare Indian households spends a disproportionate share of their consumption expenditure on health. Public spending on health is very low, stagnant at about 1% of GDP, putting India among the bottom 20% of countries, according to the India Health Report 2010 by CII and Indicus Analytics. The study said the households spend an average of 7% of their total expenditure on medicine and healthcare. Private health spending accounts for more than 80% of all health spending in India and one of the highest proportions of private spending anywhere in the world, the study depicted. Per capita costs have almost doubled in the last decade, across both in-patient and out-patient care. In rural areas, per capita out-patient cost increased from `11 to `20, while urban areas showed an increase from `14 to `28, the report said. The average expenditure incurred for one case of hospitalisation is about `7,182 with government hospitals stand at about `3,454 and private at `8,828. Even the poorest 20% in rural areas spend about `4,291 on one hospitalisation case, the study said.

Corporate Social Responsibility

Hospital Information System

Philips to address the need of aging populations

Siemens launches Soarian MedSuite HIS for the first time in India

Philips has declared its commitment to helping address the healthcare needs of aging populations. In his speech entitled ‘Towards Next Generation Home Healthcare’, delivered at the 2010 Nikkei-Philips Symposium, Erik Sande, General Manager, Philips Home Monitoring, reconfirmed the decision on behalf of the corporate major. The company through its home healthcare division stressed the need for sustainable, ‘next generation’ solutions that are reliable, easy-touse and address the issue of how to help the elderly and chronically ill to live full and rewarding lives. The corporate has also come out with its outlined strategic ‘Vision 2015’ plan to further strengthen Philips’ leadership in the domain of health and well-being focused on growth and strengthening leadership.

Siemens has recently announced the launch of ‘Soarian MedSuite’ hospital information system (HIS) for the first time in India. The implementation of this system has been successfully completed at SL Raheja Hospital in Mumbai, also a Fortis Healthcare associate. Soarian MedSuite helps hospitals to provide better patient care and drive clinical excellence by effectively integrating various processes. It also enables hospitals worldwide increase efficiency by arming caregivers with integrated tools to manage administrative, clinical and financial processes. The solution yields immediate access to patient data across the spectrum of care.

> www.ehealthonline.org > October 2010

NEWS REVIEW

Medsynaptic conferred with Emerge Award by NASSCOM NASSCOM has announced Medsynaptic, a pioneering and leading Teleradiology and PACS company from India, as one of the top 10 Information Technology startups for 2010 at the Delhi edition of the NASSCOM EMERGOUT Conclave 2010. The winners, chosen from a total of 236 initial applicants, include companies that provide a range of IT services covering healthcare, education and training, banking, travel and social networking. NASSCOM through its EMERGE 50 initiative has identified 50 Emerging companies which are redefining the benchmark of excellence for the next generation of SMEs. The League of 10, have been selected from these shortlisted companies. The purpose of this initiative is to identify and recognise the great potential companies in the making, who can be treated as role models and inspiration to others.

Corporate Partnership

Aurigene and Pcovery merges for anti-fungal drug discovery Aurigene Discovery Technologies Ltd, a collaborative drug discovery company has signed a drug discovery deal with Danish start-up Pcovery, which designs and develops original drugs and agrochemicals. Under the terms of this agreement, the companies will work collaboratively to progress early hits available with Pcovery through the drug discovery cycle up to IND submission for anti-fungal indications. Aurigene will support Pcovery through its structure based discovery approaches and medicinal chemistry expertise to advance the early hits from Pcovery. Financial details of the deal have not been disclosed.

October 2010 < www.ehealthonline.org <

NEWS REVIEW

NIH launches research into human immune responses The National Institutes of Health (NIH) has launched a nationwide IT-supported research initiative using human studies to define changes in the human immune system in response to infection or to vaccination. The researchers will take advantage of technological developments and advances in creating databases and developing mathematical models to identify and analyse the complex changes in immune profiles. The funding is a total of US$100 million over five years will come from the National Institute of Allergy and Infectious Diseases (NIAID), a part of the NIH and support for the first year of the initiative will come from the American Recovery and Reinvestment Act (ARRA). Investigators will analyse samples from wellcharacterised groups, including children, the elderly, and people with autoimmune diseases such as lupus. These groups represent diverse populations with respect to age, genetics, gender and ethnicity. The research teams will examine immune system elements of these populations before and after exposure to naturally acquired infections or to vaccines or vaccine components.

Merger & Acquisition

Transasia acquires a majority stake in IVAX Transasia Bio-Medicals through its fully owned German subsidiary, Erba Diagnostics Mannheim GmbH has acquired a majority stake in US based company IVAX Diagnostics. IVAX is a fully integrated In-Vitro diagnostics company that develops, manufactures and distributes in the US and internationally, proprietary diagnostic reagents, test kits and instrumentation, for Autoimmune and Infectious diseases. The synergy thus developed will help Transasia to offer unique Immunodiagnostic innovations in its products, procedures and in the development of Integrated Instrument and Reagent systems for both Autoimmune and Infectious Disease and will help IVAX to increase its reach in the Indian market.

Telemedicine

Research Update

Zargis for remote stethoscope solution

Maternal deaths fall 34%, reports WHO

Zargis Medical has signed an agreement with the Ontario Telemedicine Network (OTN) providing for the delivery and testing of Zargisâ&#x20AC;&#x2122; telemedicine stethoscope system, Zargis TeleSteth. OTN provides access to care for patients in every hospital in Ontario and the healthcare centres across the province. Through the agreement, a wide-scale implementation within OTNâ&#x20AC;&#x2122;s network of more than 1,100 clinical sites have been anticipated. TeleSteth helps to extend the sound of auscultation to situations and environments where face-to-face encounters are not always convenient or feasible that allows healthcare professionals to share heart, lung and airway sounds with colleagues located across the globe using the Internet or a private network in real-time or store-andforward mode.

Deaths from complications during pregnancy and childbirth in India have fallen by a third in the past two decades but 1,000 women still die needlessly every day, the World Health Organisation said recently. Women in poorer countries are 36 times more likely to die from pregnancy-related causes than those in the rich nations, the WHO said, announcing maternal mortality figures that remain far above the United Nationsâ&#x20AC;&#x2122; flagship targets. For maternal mortality rates to hit the UN target, there would need to be an annual decline in deaths of 5.5% from now until 2015. The rate of decline since 1990, when there were 546,000 pregnancy-related deaths, was 2.3%. The four major causes of maternal mortality are severe bleeding after childbirth, infections, hypertensive disorders and unsafe abortions, according to the WHO figures.

> www.ehealthonline.org > October 2010

NEWS REVIEW

Google launches Health Speaks in Arabic, Hindi and Swahili Google has launched â&#x20AC;&#x2DC;Health Speaksâ&#x20AC;&#x2122; to increase the amount of online health information in languages other than English to establish the fact that language should not be the barrier to access to health information for the local communities. Health Speaks will begin with pilot projects in Arabic, Hindi and Swahili. Bilingual volunteers are encouraged to translate health-related Wikipedia (EN) articles into one of these three languages, using the Health Speaks website and Google Translato Toolkit. The next step will be to consider expanding into other languages or using content from other sources.

Product Watch

Konica Minolta develops wireless cassette-sized digital radiography system Konica Minolta Medical has launched a lightweight, wireless and cassette-sized digital radiography system. The detector has a dimensions of a film cassette so it will fit in an existing wall-stand or table bucky tray without modifications. The new cassette-sized digital radiography system will consistently provide high quality diagnostic images and is lighter than 3 kgs, incorporates a unique battery design that provides extended battery life and very short charge cycle.

October 2010 < www.ehealthonline.org <

NEWS REVIEW

Now IITs to Offer MBBS Course IITs will now offer MBBS degree. In due course of time it will also offer post graduation in medicine and its allied courses. The decision was taken in a recent meeting of the IIT Council headed by Kapil Sibal, Union Minister, Ministry of Human Resource Development, while the Ministry of Health has opposed the decision. To introduce the new courses, the Institute of Technologies Act will also be amended, decided the council. Only IIT Kharagpur will be setting up a medical school at the first phase. It had also set up the School of Medical Sciences and Technology (SMST), earlier in the year of 2000 but has been struggling since its inception to retain students. But other IITs are also already pursuing interdisciplinary research study in the area of medical sciences. When IIT has been trying to establish interdisciplinary research as one of the key focus areas, it was alleged that almost 50% of the MBBS graduates who joined the course left MMST mid-way as the school failed to attract doctors as faculty. The health ministry has given its negative remarks stating reasons that it is better for the engineering schools to start individual courses on health information technology or biomedical engineering and e-health rather than introducing a full fledged MBBS course. But IIT Council is trying to focus on its long-standing proposal to enter into medical education to promote interdisciplinary research involving medicine and engineering together. There are 15 IITs at present, located in Bhubaneswar, Bombay (Mumbai), Delhi, Gandhinagar, Guwahati, Hyderabad, Indore, Kanpur, Kharagpur, Madras (Chennai), Mandi, Patna, Punjab, Rajasthan and Roorkee. The proposed amendments will deal with two distinct ways to include MBBS into its discipline. For courses rewarding a degree for the practice of medicine, permission for clearance will be taken from the Medical Council of India

The decision by IIT Council is aimed at promoting interdisciplinary research involving both medicine and engineering By Sangita Ghosh De

(MCI). But for courses that are more of interdisciplinary research and do not award a degree in the practice of medicine, need not to go for any approval from MCI or any of the medical education regulators. According to Sibal, the council is in the process to make sure that wherever the instruction leads to a degree relating to any branch of medicine (including MBBS), then of course clearances from MCI under the Act will have to be taken. The council can also admit up to 25% foreign students at the post graduate level on a â&#x20AC;&#x153;supernumerary basis without affecting the present admission norms for Indian studentsâ&#x20AC;?. Further to this, the IIT Council has declared that it would be collaborating among IITs and also interested in partner-

> www.ehealthonline.org > October 2010

ing with other institutions in the field of greater interdisciplinary research with other institutions as well. A permanent standing committee under R A Mashelkar, former head of Council for Scientific and Industrial Research has been set up to look further into the matter. The committee has also been enabled, along with IIT council, to take decisions on global collaborations, where IITs would set up centres for policy studies to serve as an advisory forum for policy formulation and conduct research in strategic areas. The IITs which has been facing faculty crunch for a long time will now also be able to recruit faculty from abroad. The council has given a go ahead to the IITs to recruit foreign nationals, with a maximum limit of 10% of permanent faculty.

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Build security, end blood scarcity Well-coordinated chains of mother banks and storage centres, supported by NGOs and altruistic donors, is the way to go By Dr Rajesh Gopal

lood security exists when all people have equitable and timely access to safe blood. Sufficiency, safety and suitability constitute the three pillars of blood security. India does have a sound national blood policy, but the absence of a fully coordinated national blood service renders a patient hapless and helpless at critical moments. Safety of blood was ushered in an effective manner after the landmark judgment from the Supreme Court of India on January 4, 1996, which led to banning of paid blood ‘donation’ by the professional blood sellers, effective January 1, 1998. The office of the Drugs Controller General of India and the respective Food and Drugs Control Administration department of the states are expected to closely monitor blood donation services in the country in liaison with the National and State Blood Transfusion Councils. The National AIDS Control Organisation

(NACO) and the State Blood Transfusion Councils have taken myriad steps to improve screening, processing and storage of blood for utilisation by end users. But there still is a severe shortage of accessible blood with varying levels of safety of the same throughout the nation. There are more than 2,000 blood banks in the country. A significant number of these are partially regulated and even unregulated, with profiteering often being the main motive. The available global evidence indicates that perhaps even with a significantly lesser number of the blood banks functioning efficiently with appropriate linkages, the dearth of accessible safe blood may easily be tided over. We need to have more and properly trained lab technicians, fewer but more efficient blood banks, and district-level agencies that can handle all the processes necessary to make safe blood available to the needy.

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A centralised database of ‘safe’ blood donors accessible to all, say through the Websites of the State Blood Transfusion Councils can make a big difference. In most countries in the world, including many developing countries, blood services are run by the national, provincial or local self government or by organisations like the Red Cross and Red Crescent Societies. The patients admitted to a hospital are thereby assured of the blood required for their treatment. This is in accordance with the classification of blood as a drug and the health care providers must, therefore, be in a position to ‘indent’ for safe blood just the way it is done for other drugs from the stores division of hospitals. In our country, there is an absence of a centralised management of blood services, which results in lack of standardised practices and processes, poor quality standards, inadequacy of blood availability, and a nearcomplete neglect of those requiring regular transfusions due to chronic disorders. We must plan to address the issue of blood security by setting up a centralised blood collection and processing system at the mother blood banks and storage centres, on a pilot basis. A few mother blood banks supported by organisations of voluntary donors, but run by professionals, will have to be roped in. Blood collected from voluntary blood donors will be processed using standardised and quality operating procedures at the mother blood banks. It will then be distributed to storage centres with maintenance of cold chain and stored according to standard operating procedures. Participating hospitals will simply have to indent the required units of blood from the mother blood banks or storage centres. The existing blood banks in hospitals may function as storage and cross-matching centres. A modern health care system cannot function effectively without a blood service that assures blood security to all. Access to safe blood must be perceived as a right of the patient. The author is Managing Director of Gujarat State AIDS Control Society and Gujarat State Council for Blood Transfusion

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Dates - December 15 - 20, 2010 Association of Surgeons of India initiative : Supported by Quality Council of India (NABH) On display:

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Room No. 5010C, Teaching Block, AIIMS, Ansari Nagar, New Delhi-110029, India Tel: +91-11-26593460, 26588259, Fax: +91-11-26588259, Helpline: +91-99 108 57000 Email: asicondelhi@gmail.com, info@asicon2010.org